Nearsighted Focus: Gaining Insight into Myopia in New Zealand

Myopia Landscape in Focus: A Global and Regional Concern

Globally, eye health professionals have been discussing the rise of myopia for decades. Some believe it is the next epidemic, a worldwide crisis and the negative outcome of the changing lifestyles of humanity; while others cite growing access to eyecare services and health literacy for increased prevalence rates. Regardless, the reality is that the volume of patients visiting optometrist clinics requiring myopic prescriptions has increased in recent years. In a nation that celebrates the great outdoors, but that has limited knowledge of the state of its national eye health, how is myopia trending?

Earlier in the year, Specsavers underwent a special review of its deidentified patient records from across Aotearoa to better understand the prevalence of myopia among children presenting to optometrists, and how it compared to other countries. The ambition was to improve its evidence‑based strategy for providing best care for patients with myopia and to better integrate tools that could assist optometrists as they worked with patients and their families to manage and treat the condition. It was determined that myopia would be defined as per the International Myopia Institute as a spherical equivalent refraction of equal to or less than ‑0.50D in one or both eyes, with high myopia being equal to or less than ‑6.00D1.

Specsavers' focus on myopia

As the country’s largest eyecare provider, Specsavers is dedicated to developing evidence‑based strategies to eliminate avoidable vision loss for patients. Over the years, this has included focussing on eye conditions such as glaucoma, which used to have an industry standard of only a 50% detection rate yet is now nearing 90% detection rates at Specsavers practices thanks to the implementation of technology and clinical processes aligned with RANZCO Referral Pathways.

Specsavers also recently signed an agreement with Diabetes NZ with a shared ambition to work together to devise and pilot a strategy to impact patients with diabetes.

While we’ve been working on decreasing vision loss outcomes from various eye health pathologies, we also want to enhance health outcomes for those patients with vision conditions like myopia, which affects so many young people in our nation.

While these vision conditions don’t have the same life impact as sight‑threatening diseases, they are more common and increase risk factors for various eye conditions further down the track. The potential impact of optometry is also heightened for vision conditions, as treatment and management tools can be prescribed without a referral.

Incidence and average age of diagnosis shifts

In the five‑year period from 2017‑2022, 507,292 patients aged 18 and under received eyecare services from Specsavers’ 58 practices. In this timeframe, while volumes increased, the rate of myopia remained relatively stable with 32.6% of patients presenting as myopic in 2017 and 29.8% in 2022. Interestingly, the average age of first diagnosis was 14.2 years in 2017 and 13.2 years in 2022.

The prevalence of myopia varied by region also, with 32.5% of North Island children having a myopic prescription and just 25.9% in the South Island.

A smaller subset of data allowed us to also break down the prevalence in children by region. From November 2021 until October 2022, myopia was most prevalent in Auckland (39% of patients aged 18 and under) followed by Waikato (29%). The regions with the lowest prevalence of myopia were Taranaki (19%) and Hawke’s Bay (20%).

While its data helps to uncover the myopic trends being diagnosed over the past five years, we want to make clear the potential impact of COVID‑19, as the extended lockdowns and increased indoor time may have led to an increased prevalence of myopia in children in a portion of the timeframe analysed. It was important to note that these numbers represent the percentage of children seen by optometrists who are myopic, not the prevalence of myopia in the wider community. As emmetropic children are less likely to attend an eye test, this number may over‑represent the population prevalence of myopia.

Comparison with Australia

New Zealand experiences many similarities with its Trans‑Tasman neighbour, Australia. There are similarities in the capacities and capabilities of the optometric profession, Specsavers’ own practice processes in both countries and the similarities in the culture and lifestyle of its patients.

While analysing the myopia data for New Zealand, we also reviewed more than 2.6 million deidentified patient records from Specavers’ Australian practices – every patient we saw aged 18 or under who presented to a Specsavers practice in the same five‑year period.

In the data, it was found that the percentage of children with myopia was significantly lower in Australia in 2017 (24.6% of children aged 18 and under compared to NZ’s 32.6%) but that the rates of diagnosis levelled out by 2022 (28.8% in Australia and 29.8% in NZ). One possible explanation for this is that children are less likely to attend eye care in New Zealand than they are in Australia, especially when they don’t have any perceived vision problems. Similar to NZ, the age of first diagnosis in Australia moved from 14.6 years in 2017 to 13.3 years in 2022.

The prevalence of myopia also varied by location. In Australia, surprisingly, the sunniest state, Western Australia, saw the highest levels of myopia (34.3%), whereas the wettest state, Tasmania, saw the lowest levels (20.9%).

Comprehensive Myopia Management: Taking a Holistic Strategy

With a better understanding of myopia in its patient base, Specsavers is working to improve vision and eventual health outcomes for children with myopia across Aotearoa. The holistic approach involves early intervention and management tools, patient and optometrist education and ongoing analysis of data trends.

Specsavers optometrists in New Zealand are prescribing therapeutic spectacle lenses, contact lenses and low‑dose atropine eye drops as key myopia management products for accredited optometrists to prescribe to appropriate patients.

We’ve seen the evidence to know that these products are successful in reducing myopia in patients so we’re proud to now have them available for our patients. To ensure effective prescription, dispense and support, we developed training and accreditation on myopia management products for both optometrists and retail team members. We also developed a separate training module for other dispensing and retail team members, ensuring appropriate knowledge and enabling all team members to support myopia management in practices.

As myopia becomes more of a focus for the nation’s largest optometric provider, it will be interesting to see the impact it has on the people of Aotearoa. Specsavers has committed to sharing its insights and learnings with NZ Optics as it progresses in this area.